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Author
Topic: Atripla Cost (Read 40489 times)

I was looking over my prescription benefits for the past year and this year. Sometime around July '08, Atripla went from around $1370 to $2800, where it's remained. I thought that was odd and asked a friend who's a pharmacist. He quoted me the non-discounted retail rate from a national chain of around $1787. He said there's generally a negotiated discount with major insurance companies. I asked my pharmacy what the retail price was and was quoted around $2800. Then, the lady said that that was for a 60-day supply, and that it was around $1378 for a 30-day supply. Considering my drug plan doesn't cover 60-day refills, I can understand her confusion. What's bothering me is that it appears that my insurance company is being billed almost $15,000 more a year than it should. I've reported the discrepancy to the company that handles drug benefits for my insurance, but they didn't seem all that interested in it. The second lady that I talked to did at least make a report. Being that insurance is a major cost to employers, I'd hate to have mine paying that much more than necessary. Have others had weird billing issues like this with their meds? What are other insurance companies paying for Atripla?

Keep in mind that what the insurance company is billed and what it pays can be vastly different. The Aetna Mail Pharmacy bills Aetna over $5000 for my 90 day supply of Atripla, but Aetna pays (themselves) only about $4200 for it.

Keep in mind that what the insurance company is billed and what it pays can be vastly different. The Aetna Mail Pharmacy bills Aetna over $5000 for my 90 day supply of Atripla, but Aetna pays (themselves) only about $4200 for it.

Screwy, I know -- but that is what it is for me.

Mike

$4200 for 3 months is about right, I think. The $2800 per 30-day refill is what my insurance pays. Something's wrong, as my insurance company is paying roughly twice what yours is for the same meds. I don't believe I have a life-time maximum for meds or in-network procedures, fortunately. Oddly enough, my insurance company doesn't want to pay for generic Allegra ($45 / month) but has no problem paying over $1300 extra for Atripla! No wonder health, drug, and insurance expenses are so high!

I remember the first time I saw on the Walgreens receipt how much "your insurance saved you" on Atripla. I nearly wrecked the car! Not only is it dangerous to take Atripla at $60 a pill over the sink with running water, I don't recommend reading the pharmacy receipt as you pull away from the drive through window!

DavidNC...I have the same issue regarding Allegra. What a hoot! They will fight tooth and nail over an inexpensive drug and then fork over four figures a month for Atripla. Thank goodness of course...but it shows the lunacy of our current "for profit" system. Complaints notwithstanding (it's our constitutional right!) I am very thankful for medical insurance.

I belong to Caremark and generally get prescriptions at Walgreens, but by getting them directly through Caremark at 90 days at a time, it cuts the cost in a third for my out of pocket. I can't get authorized at Walgreens for a 90 day supply, but I can through Caremark. I have no idea why. I'll run the numbers and show you though, similar I think to what you said.

Jacobm, my drug benefits used to work like that. Last year, I could get a 3-month supply for like $50 copay. I just checked, and if I get it through Medco (the company that handles our Rx benefits), a 90 day supply is $90 (duh, Rx for 90 days at my pharmacy is $90). I wonder what changed with Medco.

I am on mail order now. We get 90 days for two copays. So 90 days of Atripla= $100.00. If I filled at Walgreens (30 day limit there) it is $150. Naturally over the year that equals a $200.00 cost differential so it is a no-brainer.

My BC/BS policy uses Medco to fill my prescriptions. They pay $1404.00 for a 30 day RX from Rite Aid.Recently I began getting a 90 day supply directly through Medco. They claim the cost is $3852 for a 90 day supply or $1380 per 30 days. Luckily I only pay $30 for my 90 day supply.

David you have done the good deed making your insurance company aware of the issue. You could follow up a bit if you think they are being bilked! Good for you. If after one or two more tries, they really don't care, then tough for them!

I have a comment to make about losing pills. Since people brought it up.

This was a big fear of mine - that I would have to pay for lost pills or mistakes. I heard horror stories from people, even in this forum, of very strict delivery and people even missing days because of insurance and payment stuff.

I discussed this with my ID in Switzerland and my pharmacist and the situation here is clear - when you need the pills, you ask, and you get. How nice! Also, the pharmacist has been just lovely about setting me up and explaining the copays, etc.

My next fear was traveling. I travel a lot for my job and always want some pills in my carry on and some in my suitcase. I was going away for several weeks this winter and I was so scared I might get caught in some horrible situation in a foreign country without pills.

The ID said: 1) Take a copy of a prescription.

2) Throw enough pills in the carry on and in the suitcase to make sure you are covered if something gets lost.

Nobody has counted the refills here, I had lots of extra, and threw it all in.

Well, if you gotta be on HAART, peace of mind makes it more bearable.

So what is the situation in the USA? If you are a few doses short - lost pills or something, do you really have to pay out of pocket and no insurance reimbursement? Are they counting pills??

Did you read those articles about South Africa - where kids are mugging HIV+ people to steal their Sustiva to smoke it! I hope this is replaced easily!

Whatever the cost, i count my blessings, and I hope and pray that i'll aways have an effective combination and insurance to pay for it, until the cure....

Logged

“From each, according to his ability; to each, according to his need” 1875 K Marx

David, that is good that you are trying to keep your insurance company from getting cheated. I don't know if this will help but I am on Medicade, I get my Atripla from Walmart ,and today when I picked it up, the info sheet listed the price at $1664.00. Cristy

I can't speak for the entire USA, but here in California, my Doc advised me to build up a small surplus of meds by refilling my meds a little earlier. I just refilled my Atripla yesterday after taking it for 23 days. I also can't speak for government assisted programs. I have been blessed with great insurance coverage. I also discussed this with my Blue Shield Caseworker. She said it sounded reasonable to have an insurance paid 15 day surplus over my current 30 day allotment. She brought up the natural disaster possibility such as an earthquake scenario or terrest attack that could devastate medication delivery systems. One of my old college friends is diabetic and she always has a surplus of injectables on hand. You never know when the big one might hit and I don't want to be left high and dry.

Good point about the surplus. My Rx's refill at 23 days as well. I have a month's backup of Atripla now. Don't forget to rotate your stock, though. When I get a new bottle, I pull out the existing one out of the drawer and throw the new one in. That way I've only had it a month at most. My pharmacy doesn't mind refilling my hypertension Rx after 23 days, either. Every now and then they get a bit testy about the Adderall refills! When they do, I just take it to another pharmacy.

I'm still waiting to hear back from Medco. If not, I'll contact the individual in the link posted by Assurbanipal (thanks, by the way). I'm not sure what's going on with those refills, but it seems kinda shady! Either the pharmacy is milking the State's drug benefit program or Medco is up to something. Regardless, it's not something I want to have happen when budgets are as screwed as they are now.

I can't speak for the entire USA, but here in California, my Doc advised me to build up a small surplus of meds by refilling my meds a little earlier. I just refilled my Atripla yesterday after taking it for 23 days. I also can't speak for government assisted programs. I have been blessed with great insurance coverage. I also discussed this with my Blue Shield Caseworker. She said it sounded reasonable to have an insurance paid 15 day surplus over my current 30 day allotment. She brought up the natural disaster possibility such as an earthquake scenario or terrest attack that could devastate medication delivery systems. One of my old college friends is diabetic and she always has a surplus of injectables on hand. You never know when the big one might hit and I don't want to be left high and dry.

Yes in deed David, I Will rotate my meds as directed. If the Atripla works for me, Blue Shield will mail me Atipla in 90 day increments. I do have a question for you, should I pay extra and have them expressed delivered (over night) because of the heat or cold conditions the medication may be subject to in transit. Or am I just being a bit too cautious and petty.

Yes in deed David, I Will rotate my meds as directed. If the Atripla works for me, Blue Shield will mail me Atipla in 90 day increments. I do have a question for you, should I pay extra and have them expressed delivered (over night) because of the heat or cold conditions the medication may be subject to in transit. Or am I just being a bit too cautious and petty.

I doubt it'd make any difference, really. From what I know about shipping, depending on where the meds are shipped from, they will either be in the cargo hold of a plane (very cold at altitude) and very hot sitting on the runway (if shipped overnight). I know that standard delivery will prolong those times a bit more, but if your Atripla is shipped FedEx or UPS, it'll only take a couple of days anyway. If I'm not mistaken, a while back a member posted that they'd inquired and were told that the meds shouldn't be stored at extreme temps. for long periods of time, but I don't recall any warnings about short periods, like shipping.

I have been slowly building up a surplus that is presently at about 8 months. How? I order my meds through the Aetna mail pharmacy, for a 90 day supply. I'm allowed to order a refill after 2 months. I've been doing that for the last couple of years. My plan is to get to about 10 months surplus. I rotate regularly. This surplus helps me feel secure that if something happens to my insurance, I've given myself time to work through options without the worry of my meds.

As to the question of paying extra for the expedited delivery. I don't do it -- of course, due to my Norvir needing refrigeration, my pharmacy ships it on cold packs, Next Day Air -- and they require someone to sign for it. I try to order all my drugs (Atipla, Reyataz, Norvir, lipitor, fexofenadine) all together -- which gets them all Next Day Air for free. However, before I added the Reyataz/Norvir to my regimen, the Atripla came UPS Ground and I never had any issues with it.

My grandmother always always always had a food supply in the cellar, since WWII. "You never know". And yes she would rotate it so it wasn't exploding old cans of tuna fish.I'm glad to see the situation in the states is flexible for those with insurance!

Logged

“From each, according to his ability; to each, according to his need” 1875 K Marx

When I started on Atripla 2 yrs. ago, the cost was around $1200.00/Mo. for 30 pills. Since then it has went up every month and is now almost $1800.00/Mo. for 30 pills. Luckally I only have to pay $35.00/Mo. for my Co-pay. I can't understand why it keeps going up every month, I'm just greatfull that I have insurance to cover most of the cost.

My Insurance Company, on the other hand, I am constantly arguing with. I am in a program where the state pays my Insurance premiums and guarantees my Insurance company will get their money, but if they don't get the payment by the due date, I can't get my meds until they do get the payment. This has happened every quarter when my premium comes due. I have to argue with the Insurance company and get my case worker to get it straitened out. This causes a lot of unnecessary stress for me, because sometimes I have to get my meds on a Friday, and of course the Insurance company is closed, so I have to go the weekend hoping that if I miss a dose it does not have bad repercussions.

BTW...My Insurance Company is "World Insurance". They are so sorry, that I warn everyone not to do Business with them.

you all are lucky,they say the part of the world you live in determines if you ll be killed by the virus or not i wish our govt will make atripla available for us at least more people will live to tell the story..

you all are lucky,they say the part of the world you live in determines if you ll be killed by the virus or not i wish our govt will make atripla available for us at least more people will live to tell the story..

There is a generic Atripla called Viraday, made in India and it is much cheaper. I'm not sure where you live, maybe it's not available there.

I price out Atripla some time ago and it was 1300 to 1600, CVS was willing to give me a 20 percent discount for a cash purchase. I think the fake stated prices of the insurance companies have nothing to do with what they really pay for they negoate prices on bulk at the end of the month and most insurance companies now have their own contracts with specialty pharm just for that purpose. I think that they are paying discount or what they call in the PHARM business as wholesale teir pricing of about 800 month for a 30 day suppliy at this time , however they want tell the public the price they are paying for it make them look like Mother Thersa in the good deed of allowing the insured to have excess to an expensive pill.. even if they states they 1600 hundred for 30 days supplies and end up paying 800 for 30 days.. it is marketing and the ponsee schemes of old.

ADAP here in State of Florida I am told is paying in bulk.. or cases of Atripa I understand at about 800 dollars for a month supplies.. and the is why Gilead did 500 million dollars of bussiness in the frist year of launching that drug in 2006. I wonder what they did in 2007 and 2008 for Atripla has realy taken off and put a dent in other drug company business. Some say Gilead have moved to get a bout 60 percent of the pricription market for Global AIDS including USA by the way Gilead is a old school bio tech company not a member of Big Pharma and Richard Chenny and Don Rumflied had a hand in starting the company and sure still have lot of control and stock. Funny how big government leaders and big Government contract come together. Inside track of Old School and Old Game Busisiness. The good news for us HIV folks is that we get to stay alive and others get a new boat or beach house and many get to be employee in Gilead with benifits and health insurance, for I guess a lot of Gilead's employees are thank ful for HIV folks keeping them in the cash, as we are thank ful for the drug to stay alive.

I think if we pooled all the USA funds and Unionize the negociation for the drug like any good business would do then the price would go down a lot, but as you know the Federal Government can not negoiate pricing of drugs. I think it would be cool if the New Adminisration would break the patient of Altripa by invoking a old law called Compuslary Liscencing to force Altripa into Generics and bring the price down to 30 dollars for a months supply for that would make me happy and to by it over the counter without a prisription from a Doctor would make me very happy.

Love you Gilead, however just a policy idea and hope we can agree to disagree as we all move forward in Free, and Fair trade conversation for the People of the United States of America.

P.S And part of the other Good News is that Gilead throws out a few crumbs of the Profits of Atrpla to keep the marketing going to Poz.com to help fund this web page and the Poz Magazine for you can see that Atripla is all over this publication. It is all good for we live in a free money making sociaty, now we just need to work of the Fair Trade Concept I beilieve. For one must remember AIDS is big business with 18 billion US dollar a year just from the USA Government to help treat HIV people paying for food, housing, doctor bills, medicine and other services.. and now 9 billion a year more is being allot by our USA congress to Global AIDS, yes big business , big , big business.

Viraday, very fascinating and only 198 dollars for 30 days siupplies according to one web site.. I guess the internet is going to bring fairness to this market, however for some strange reason a few sites are out of stock of Viraday the Generic to Atriple.. connecting the dot of socail justice is getting very fascinating. For now the question might be is Viraday as good as quality as Atriple or if one order via the net will it be a surgar pill or the real equivilant to Atripla. It is good to know that Viraday is out their for emergencies and I might save up a couple thousand dollars and order a couple years supply or better yet take a plane trip to a country where I can buy it cheaper to stock up for I like to move past being a slave to meds, doctors, insurance and government for a couple years for wow after 20 years of this HIV journey a couplle of years of having pills would be very cool.

I don't care who advertises where and with whom as long as information is getting out to the public and the public is getting educated. I don't get POZ at home but I read it when I go into ID doctor for my visits and lab work because the mag is in the lobby and sometimes I read some on the website. AidsMeds is the first place I read about Atripla before it's marketing approval. Having had HIV/AIDS so long I remember when there was no information available. These websites are not cheap to operate and advertising is a source of income to keep these sites free to the public. I don’t care how may med companies advertise to keep the information flowing, the more the merrier.

The American model for prescription medication is a very complex model. I have been working with securities for many years now and will explain why new drugs can be intially costly for many years.

When a drug company is in the research and develop (R&D) mode in developing a new drug, their "Book" value diminishes or does not rise during the most always elongated costly R&D period. A "Book" value is the net worth of a publicly traded company divided into the number of diluted shares. Shares owned by the company (or Government now, ha ha) are not factored into the net "Book" value. When a new drug is finally approved, the cost of R&D is divided into actuarial market demand of the product and number of years the company has total market share of the new drug. Thus the new drug is very expensive and can go higher or lower in price depending on market demand during the exclusive market share period. A profit margin is also factored into the exclusive market share period. Profit margins are driven by market demands.

Atripla does not cost $60.00 a pill to manufacture and market. Much of the $60.00 per pill is going back to the company's "book" value. When a new drug fails, the company never recoops the lost "book" value thus the stock price goes down. When a drug is a success, the "book" value will rise, thus the stock price will rise.

This is the American model...like it or not, it delvers results. Also, this information is public information and readily available.

Nice try in your explanation of a complex matter, however I can simplify the matter for other too,

It is called Greed ...and like it or not GREED and POWER of a BUCK and it is not very complicated at all.

Good try and who do you work for Big Pharma?

Peace

Be thankful there are companies doing research and development of these drugs for HIV. They could all throw their hands up and work on more common diseases with cheaper R&D costs. I have lost a lot of friends that would have loved to live long enough to be able to have any of the meds that are now available to us, you know they may still be alive today had they had the choice and the chance.

I am very thankful, but you have be listening to the proproganda of Pharma, for if they were not making big money than they would not be in this business. That is a lot of bull shit that the Pharma team is putting out to scrare people, wow when the advocates get in bed with the money machine the voice changes quickly. Shame , Shame , Shame on you dude for advocating for Pharma in your words.. what about the 30 million HIV folks that don't have HIV MEDS.. Do you care about them or is it all about you keeping the crumbs that Pharma is buying you with?

I am very thankful, but you have be listening to the proproganda of Pharma, for if they were not making big money than they would not be in this business. That is a lot of bull shit that the Pharma team is putting out to scrare people, wow when the advocates get in bed with the money machine the voice changes quickly. Shame , Shame , Shame on you dude for advocating for Pharma in your words.. what about the 30 million HIV folks that don't have HIV MEDS.. Do you care about them or is it all about you keeping the crumbs that Pharma is buying you with?

Peace

Facts are facts and the fact is if there weren't Pharama companies doing research and development and providing those drugs for you to take you wouldn't be here. If you have such a hard on for the Pharma companies that provide the drugs for you to purchase quit taking them.

Again you are right about the facts that is good news for I like Pharma and have had dinner with lots of the folks in Pharma and made them lots of money in the past.. however as a leader I don't agree with all their policies for it is my right to disagree with policies, however love my Greedy Pharma folks it is all good.

And the other facts of 30 million people not having acess to HIV meds is a fact too .. and what is your solution to help our HIV brother and sistier out.. or do you care?

Rob this is a channlege for you to use your critical thinking skills and leadership for the woman, men and children that are depending on your compassion voice and action.

Again you are right about the facts that is good news for I like Pharma and have had dinner with lots of the folks in Pharma and made them lots of money in the past.. however as a leader I don't agree with all their policies for it is my right to disagree with policies, however love my Greedy Pharma folks it is all good.

And the other facts of 30 million people not having acess to HIV meds is a fact too .. and what is your solution to help our HIV brother and sistier out.. or do you care?

Rob this is a channlege for you to use your critical thinking skills and leadership for the woman, men and children that are depending on your compassion voice and action.

Peace

I see no sense even wasting anymore time with you. By the way my name is not Rob.

I will not give up on you for I feel confident that you are a man of honor, truth and intergety and will be a man of crourage in the future to join in to help the 30 million women, men and children that do not have the blessings that you have concerning HIV meds.

Unfortunately, open forums like this sometimes get highjacked by agenda driven individuals.

The two links below will provide 3 year historical stock prices for Bristol Myers Squibb and Gilead. Rather stable stock prices since Atripla came to market. No big stock options I see for the big Pharma folks I see...ha ha, I love facts.

Unfortunately, open forums like this sometimes get highjacked by agenda driven individuals.

The two links below will provide 3 year historical stock prices for Bristol Myers Squibb and Gilead. Rather stable stock prices since Atripla came to market. No big stock options I see for the big Pharma folks I see...ha ha, I love facts.

Again you are not using your critical thinking skills for the stock prices are not reliyable for it is clear by all the schemes that they mean nothing about the truth for look at the history of the last year.

Second again you are assuming that someone is taking something away from your control to disagree with you thoughts and others.

Third I was adressing the AIDS drug market not the stock market and you might want do research on all AIDS drugs for my sources are stating that Atripa has 50 percent of the AIDS drug sales and growing to 60 percent.

Fouth you attempt to use a staw hat falacy is not a good arguement for the truth that Atripa is a winning drug and moving the RX AIDS market to a new level and with their new drug they could capture 80 percent of the market I believe and with Johnson and Johnson new drug Presita .. it may be called the Cure in the future giving HIV people a 1st teir treatment, Second teir treatment with one pill and then a safty net with Presita.

Need to sign off for today and complete my studies for I am working on a Bachlors Degree and need to change work mode.. Peace Out..

Despite how the system works, Big Pharma has a lot of tricks up its sleeve in order to bilk customers and make unfair profits. There was a fascinating piece on this subject written by Malcolm Gladwell called "High Prices: How to Think About Prescription Drugs" that appeared in The New Yorker in 2004. In it he details what AstraZeneca did with Prilosec in order to continue to reap huge profits even after their patent expired.

Ten years ago, the multinational pharmaceutical company AstraZeneca launched what was known inside the company as the Shark Fin Project. The team for the project was composed of lawyers, marketers, and scientists, and its focus was a prescription drug known as Prilosec, a heartburn medication that, in one five-year stretch of its extraordinary history, earned AstraZeneca twenty-six billion dollars. The patent on the drug was due to expire in April of 2001. The name Shark Fin was a reference to what Prilosec sales—and AstraZeneca’s profits—would look like if nothing was done to fend off the ensuing low-priced generic competition."

They basically "turned" Prilosec into Nexium and, Voila, a "new" drug was born.

Nexium has become a symbol of everything that is wrong with the pharmaceutical industry. The big drug companies justify the high prices they charge—and the extraordinary profits they enjoy—by arguing that the search for innovative, life-saving medicines is risky and expensive. But Nexium is little more than a repackaged version of an old medicine. And the hundred and twenty dollars a month that AstraZeneca charges isn’t to recoup the costs of risky research and development; the costs were for a series of clinical trials that told us nothing we needed to know, and a half-billion-dollar marketing campaign selling the solution to a problem we’d already solved. “The Prilosec pattern, repeated across the pharmaceutical industry, goes a long way to explain why the nation’s prescription drug bill is rising an estimated 17 % a year even as general inflation is quiescent,” the Wall Street Journal concluded, in a front-page article that first revealed the Shark Fin Project.